Get Naturopathic Treatment for PCOS in Toronto

FAQS on Naturopathic PCOS treatment

How Can a naturopath help with PCOS?

PCOS is a complex condition that presents in many ways, through various life stages and is particularly well-supported by our individualized naturopathic approach to care. Taking a holistic approach to PCOS allows patients to be fully supported for their specific needs at the time, while preventing future health problems. Our naturopaths offer diagnostics, nutrition, supplements, herbal medicines and bioidentical hormone replacement therapies to support our patients in managing their symptoms of PCOS.

What are the 4 types of PCOS?

The Official Types or Phenotypes

There are four main phenotypes of PCOS as outlined in Dr. Fiona’s book “8 Steps to Reverse Your PCOS”. These types are based on the Rotterdam criteria listed above. The first consideration is that to be diagnosed with a “type” other conditions must be excluded first.

1. Type A is also known as “Classic” PCOS. It includes all 3 symptoms: hyperandrogenism (too much testosterone or similar hormones) , polycystic ovaries on ultrasound, and anovulation or delayed ovulation. Type A PCOS patients are the most likely to be insulin resistant and to have metabolic dysfunction.
2. Type B includes both hyperandrogenism and anovulation.
3. Type C includes both hyperandrogenism and polycystic ovaries- with normal ovulation.
4. Type D includes polycystic ovaries and anovulation.

However, there are major problems with these as static types. The Androgen Excess Society states that PCOS is a condition based in hyperandrogenism, and that this factor must be present in all conditions of PCOS. This would mean that Type 4 is not truly a type of PCOS.

We tend to agree. If there are no clinical symptoms OR lab values suggesting high levels of androgens/testosterone, our naturopathic doctors will look for other potential causes of anovulation and polycystic ovaries. Polycystic ovaries and delayed ovulation is common in adolescents, after stopping birth control pills, in hypothalamic amenorrhea and in other situations of hormonal imbalance.

Other Types and Variations of PCOS including Classic and Lean PCOS

There is a major difference between what is commonly described as “lean” and “classic” PCOS. Patients with “Classic” PCOS often have insulin resistance, and have difficulty losing weight around their abdomen despite great efforts. Excess insulin in these patients directs the ovaries to produce testosterone, adding into the cycle of PCOS. Most patients with classic PCOS have a great deal of inflammation, since insulin resistance causes inflammation.

To learn more about the cycle of PCOS and how insulin plays a role, please read this article and diagram here.

Once you have viewed the diagram above, it's easy to see that “Lean” PCOS is quite different from “Classic” PCOS. We see a great many patients at the clinic with lean PCOS who come in following strict diets, taking supplements and are not seeing any change at all. This is because these treatments are focused on the incorrect area. Patients with lean pcos often have androgen excess, a deficiency of progesterone and/or estrogen and many also have adrenal androgen excess. Patients with lean PCOS generally do not benefit when all the treatment is focused on insulin resistance. Some patients with lean PCOS will have inflammation but as a whole it is generally seen less than in classic PCOS. In lean PCOS, inflammation may or may not be present. We find that cyclic progesterone therapy is exceptionally helpful in treating lean pcos.

Adrenal PCOS

Adrenal PCOS is another subtype where the predominant androgen in the patient is DHEA-S.

We do consider adrenal PCOS to have some unique characteristics and therefore do offer specific support for this condition. The main adrenal androgen, DHEA-S is unable to activate the androgen receptor in cells directly. It must be turned into testosterone to become an active androgen in the ovaries and tissues. Therefore, it is almost always true that the ovaries are involved as well and the degree to which adrenal androgen excess is a problem varies from person to person. Factors to consider include whether the patient has high levels of cortisol, testosterone/direct androgens and if ovulation is affected.

Estrogen and Progesterone Levels in PCOS

During their reproductive years, patients with PCOS commonly have difficulties with hormones such as progesterone or estrogen. At our clinic, we consider these to be “factors” that are unique to individuals and must be individually assessed. It is definitely a myth that all patients with PCOS have high levels of estrogen. In fact, we see that a large subset of patients actually have low levels of estrogen for much of the time. Most patients with PCOS have low levels of or exposure to progesterone.

Inflammation in PCOS

Inflammation is common in Classic, Insulin resistant pcos since insulin resistance is a driver of inflammation. In general, we screen all of our patients for inflammation through blood testing. Other causes of inflammation in PCOS vary from patient to patient and include androgen excess, autoimmunity, infections, allergies, histamine and gut problems. This is always assessed in a holistic manner.

Can adrenal PCOS go away?

Adrenal androgens such as DHEA-S do naturally decrease with age. As a woman enters her mid 30s, adrenal androgens may decrease to the normal range. The same is also true for testosterone levels which can normalize with age (though to a milder degree) In perimenopause in PCOS, however levels of adrenal androgens may temporarily rise again.

It is important to understand once again that the adrenals are only a source of androgen precursors and that if levels have normalized, the overall health picture of PCOS may still be present. This can be identified easily through assessment with your naturopathic doctor. PCOS is generally considered to be a lifelong condition so even though specific elements may improve, there are always new considerations for each life stage.

Which exercise is best for PCOS?

Exercise is a key component of health for women with PCOS. Exercise benefits insulin resistance, mood, and boosts metabolic rate!

Although many types of exercise can be helpful for PCOS there are certain types that seem to provide the most benefit. First, the best type of exercise is the type you enjoy and the type you will do! Outside that, there are generally a few types of exercise that stand out for PCOS.

1. Strength Training in PCOS

   • Strength training can provide a major metabolic benefit for women with PCOS.
   • A great place to start is by building your lower body strength — the leg muscles have the most impact for PCOS.

   Key Strength Building Lower Body Exercises for PCOS:

   • Squat
   • Lunge
   • Deadlift
   • Step-Ups

2. HIIT — High Intensity Interval Training

   For patients who enjoy cardiovascular exercise, HIIT training has been found to benefit PCOS. This exercise is more intense and should not be performed by those with exhaustion, debilitation.

What should not be eaten in PCOS?

There really are no foods that should “not” be eaten in PCOS. We focus on the “dos” rather than the “don’t’s”. Rather than cutting foods out, it is beneficial to follow a balanced diet that provides an array of micronutrients through healthy fats, lean proteins, vegetables, fruits and low glycemic index carbohydrates. At the clinic always educate our patients with PCOS on how to create a balanced meal with healthful choices, and how to proportion different macronutrients to help manage blood sugar and insulin levels. We also provide information on optimal meal timing for metabolic and adrenal health!

How does apple cider vinegar help PCOS?

Apple cider vinegar can support blood sugar levels and glycemic control in PCOS. It also can benefit digestive health, and provides biliary support in the condition.